Was the research done independently, and if not, was it paid for by a drug company?
And if the results are favourable about a particular drug, can you be sure that other less favourable results have not been censored or suppressed?
If those questions seem too dramatic or conspiratorial, there is plenty of evidence to back them up in a new book by New York Times reporter, Melody Petersen.
Our Daily Meds tells the story of how the pharmaceutical industry in recent decades has made a huge switch towards promoting drugs with gigantic sales and public relations budgets.
And Ms Petersen says many of the drugs they do promote are questionable, as in the case of the hugely popular drug Vioxx, which was withdrawn from the market in 2004 because of concerns about increased risk of heart attack and stroke.
She says the the big pharmaceutical companies in the US have a two-pronged sales attack - on doctors and on consumers.
“This is actually one thing that is different in Australia and in America. In Australia the drug companies can’t advertise directly to consumers, like they can here in the US,” Ms Petersen said.
“So what that has, what the companies do, is rely more on the behind-the-scenes promotion, which I write about in my book.
“They give nice gifts to physicians, even putting many of the physicians on the corporate payroll. They’ve made tens of thousands of doctors their paid consultants.
“They pay for fancy dinners where the doctors are educated about the newest drugs.
“To reach consumers in Australia and America with this behind-the-scenes promotion, they give grants to patient advocacy groups to help them promote a drug or promote a disease.
“They aim to put their promotional message in someone else’s mouth so that it makes it more believable.”
Ms Petersen has an astonishing statistic about the proportion of industry PR people to the number of doctors. Apparently, there is one sales representative for every six physicians in America.
“There’s half a million drug-sponsored meetings or parties or dinners for physicians every year,” she said.
“It’s hundreds per day of these parties that the drug industry sponsors for physicians where the physicians are wined and dined.
“Actually here in the US, often they’re also given a nice cheque for $500 just for attending. And then the drug industry will hire another physician to lecture them on why they should be prescribing one of these new drugs.”
Pharmaceutical promotions
When you ask doctors about this kind of practice they may say they are independent thinkers and that at the conferences, genuine information is exchanged.
But Ms Peterson says this type of promotion works very well.
“Here in the US the drug companies track the prescriptions that doctors write and they will track what prescriptions the doctor is writing before this nice party,” she said.
“Then [the drug companies] look at what happened afterwards. And so they know that it works and they actually focus the invitations to these parties on the higher prescribing physicians.”
But is Australia, with its Pharmaceutical Benefit Scheme (PBS), better insulated than America is?
“I know a little bit about what Australia does. I think that the pharmacy benefit scheme does help rein in drug costs because it’s different from here,” Ms Petersen said.
“In the US the drug companies can charge whatever they want, so it’s helped in that regard but I don’t think it has done really anything to rein in that aggressive marketing of these drugs.
“[Pharmaceutical drug companies] are doing the same sort of thing just about anywhere in the world where people, nations, have money to spend on prescription drugs.”
Ms Peterson says that one problem in Australia is that the Government has to rely on the drug industry’s clinical trials to decide what medicines to cover under the scheme.
“It’s very clear that the industry’s published clinical trials are giving us a false impression about the many new medicines,” she said.
“The drug companies have really learned to use science as just another marketing tool. They do most of the studies of these prescription drugs and if they don’t like the results of a clinical trial they simply don’t publish it.”
When a report is published in a respected medical journal, most tend to assume that this indicates some kind of genuine stamp of approval.
But as Ms Petersen explains, this can be manipulated.
“It absolutely can, and it happens all the time unfortunately. It’s very, very frightening,” she said.
“The drug industry has this marketing technique that they call ‘publication planning’. It sounds benign but it really isn’t and what it involves is they try to get as many articles published in the world’s medical journals as they can.
“One way they do this, they hire an advertising agency or a marketing firm to actually draft up these articles and then they go out and hire a doctor or a group of doctors to put their names on these articles, even though it’s been written by the ad firm.
“Some of these doctors will change the manuscript to align to their way of thinking, but some doctors don’t change a word of it.”
Over the last couple of years when Australia was negotiating with the US for the Free Trade Agreement, there was concern about the idea that big pharmaceutical companies would be able to breach the rules of our pharmaceutical benefit scheme.
Ms Petersen says drug companies have long been involved in the trade deals between the two countries.
“They [the drug companies] have so much at stake there that that wouldn’t surprise me at all,” she said.
http://www.abc.net.au/news/stories/2008/04/30/2232048.htm
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